Risk factors for cerebrospinal fluid leakage after spinal tumor surgery: a systematic review and meta-analysis

Previous studies on risk factors for cerebrospinal fluid (CSF) leakage after spinal tumor surgery have reported inconsistent findings, particularly for age, revision surgery, and surgery-related factors such as operative time and blood loss. We therefore performed a systematic review and meta-analysis to identify the most robust risk factors for postoperative CSF leakage in this population.

PubMed, Embase, Web of Science, Cochrane Library, ProQuest, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), Wanfang, and VIP were systematically searched from inception to December 2022. Eligible studies were cohort or case-control studies including adult patients undergoing spinal tumor surgery, comparing patients with and without postoperative CSF leakage, and reporting effect estimates for potential risk factors. Two reviewers independently performed study screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Adjusted effect estimates were preferentially extracted when available. Fixed and Random-effects meta-analysis was performed to pool odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs).

Seven studies were included, comprising five case-control studies and two retrospective cohort studies, involving a total of 8,319 patients. Meta-analysis showed that age >60 years (OR =1.78, 95% CI: 1.14, 2.79), smoking history (OR =1.50, 95% CI: 1.05, 2.14), revision surgery (OR =2.95, 95% CI: 1.80, 4.82), long operative time (OR =22.71, 95% CI: 6.11, 39.32), and substantial intraoperative blood loss (OR =113.92, 95% CI: 97.19, 130.65) were significant risk factors for CSF leakage after spinal tumor surgery. By contrast, male gender, multisegmented surgery, and delayed postoperative mobilization (>3 days) did not show sufficient evidence of association with CSF leakage.

Older age, smoking, revision surgery, prolonged operative time, and greater intraoperative blood loss were associated with a higher risk of postoperative CSF leakage after spinal tumor surgery. Patients at high risk may benefit from meticulous dural handling and closure, careful surgical planning to reduce operative time and blood loss, and intensified perioperative preventive management. Comprehensive preoperative evaluation, meticulous surgical planning, and attentive postoperative care should be implemented to minimize the incidence of CSF leakage.